PHOTO CHALLENGE Acute-Onset Alopecia Justin P. Bandino, MD; Dirk M. Elston, MD A previously healthy 45-year-old man presented to the dermatology department with abrupt onset of patchy, progressively worsening alopecia of the scalp as well as nausea with emesis and blurry vision of a few weeks’ duration. All symptoms were temporally associated with a new demoli- tion job the patient had started at an industrial site. He reportedcopy 10 other contractors were simi- larly affected. The patient denied paresthesia or other skin changes. On physical examination, large patches of smooth alopecia without ery- thema,not scale, scarring, tenderness, or edema that coalesced to involve the majority of the scalp, eye- brows, and eyelashes (inset) were noted. Do WHAT’S THE DIAGNOSIS? a. alopecia areata b. dioxin-induced alopecia c. phosgene-induced alopecia d. syphilitic alopecia CUTIS e. thallium-induced alopecia PLEASE TURN TO PAGE E25 FOR THE DIAGNOSIS From the Department of Dermatology, Medical University of South Carolina, Charleston. The authors report no conflict of interest. Correspondence: Justin P. Bandino, MD, 171 Ashley Ave, MSC 908, Charleston, SC 29425 (
[email protected]). E24 I CUTIS® WWW.MDEDGE.COM/DERMATOLOGY Copyright Cutis 2019. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. PHOTO CHALLENGE DISCUSSION THE DIAGNOSIS: Thallium-Induced Alopecia t the time of presentation, a punch biopsy speci- pencil point–shaped fractures that shed approximately men of the scalp revealed nonscarring alopecia 1 to 2 months after injury. The 10% of scalp hairs in A with increased catagen hairs; follicular minia- the resting telogen phase have no matrix and thus are turization; peribulbar lymphoid infiltrates; and fibrous unaffected.